CAJ | 학술논문

子宫内膜异位症%腹腔镜手术%米非司酮%巨噬细胞移动抑制因子%血管内皮生长因子%血管内皮生长因子受体1%血管内皮生长因子受体2 子宮內膜異位癥%腹腔鏡手術%米非司酮%巨噬細胞移動抑製因子%血管內皮生長因子%血管內皮生長因子受體1%血管內皮生長因子受體2
자궁내막이위증%복강경수술%미비사동%거서세포이동억제인자%혈관내피생장인자%혈관내피생장인자수체1%혈관내피생장인자수체2
endometriosis%laparoscopic surgery%mifepristone%macrophage migration inhibition factor%vascular endothelial growth factor%vascular endothelial growth factor receptor 1%vascular endothelial growth factor receptor 2

目的：观察腹腔镜手术联合米非司酮对子宫内膜异位症患者血清巨噬细胞移动抑制因子（ MIF）、血管内皮生长因子（VEGF）及其受体（VEGFR1、VEGFR2）的影响。方法选取2012年1月至2015年1月收治的子宫内膜异位症患者90例，随机分为对照组和观察组，每组45例。对照组仅采用腹腔镜手术治疗，观察组在对照组基础上联合米非司酮治疗，疗程6个月。比较2组临床疗效、1年受孕率、盆腔包块、血清hs-CRP、CA125、MIF、VEGF、VEG-FR1、VEGFR2水平、生存质量量表（EHP-5）评分及复发情况。结果（1）观察组总有效率为93 X．33％，对照组总有效率为75．56％，观察组总有效率显著高于对照组，差异有统计学意义（ P ＜0．05）。观察组1年受孕率为33．33％，对照组1年受孕率为17．78％，观察组1年受孕率显著高于对照组，差异有统计学意义（ P ＜0．05）。（2）治疗后2组盆腔包块体积、血清hs-CRP、CA125、MIF、VEGF、VEGFR1、VEGFR2水平、EHP-5评分均较治疗前有所改善，差异有统计学意义（ P ＜0．05）；但观察组改善程度优于对照组，差异有统计学意义（ P ＜0．05）。（3）所有患者均随访1年，观察组复发率为6．67％，对照组复发率为26．67％，观察组复发率显著低于对照组，差异有统计学意义（ P ＜0．05）。结论腹腔镜手术联合米非司酮治疗子宫内膜异位症疗效确切，可显著提高受孕率，降低术后复发率，改善患者生存质量，其机制与下调患者血清MIF、VEGF、VEGFR1、VEGFR2表达有关。
목적：관찰복강경수술연합미비사동대자궁내막이위증환자혈청거서세포이동억제인자（ MIF）、혈관내피생장인자（VEGF）급기수체（VEGFR1、VEGFR2）적영향。방법선취2012년1월지2015년1월수치적자궁내막이위증환자90례，수궤분위대조조화관찰조，매조45례。대조조부채용복강경수술치료，관찰조재대조조기출상연합미비사동치료，료정6개월。비교2조림상료효、1년수잉솔、분강포괴、혈청hs-CRP、CA125、MIF、VEGF、VEG-FR1、VEGFR2수평、생존질량량표（EHP-5）평분급복발정황。결과（1）관찰조총유효솔위93 X．33％，대조조총유효솔위75．56％，관찰조총유효솔현저고우대조조，차이유통계학의의（ P ＜0．05）。관찰조1년수잉솔위33．33％，대조조1년수잉솔위17．78％，관찰조1년수잉솔현저고우대조조，차이유통계학의의（ P ＜0．05）。（2）치료후2조분강포괴체적、혈청hs-CRP、CA125、MIF、VEGF、VEGFR1、VEGFR2수평、EHP-5평분균교치료전유소개선，차이유통계학의의（ P ＜0．05）；단관찰조개선정도우우대조조，차이유통계학의의（ P ＜0．05）。（3）소유환자균수방1년，관찰조복발솔위6．67％，대조조복발솔위26．67％，관찰조복발솔현저저우대조조，차이유통계학의의（ P ＜0．05）。결론복강경수술연합미비사동치료자궁내막이위증료효학절，가현저제고수잉솔，강저술후복발솔，개선환자생존질량，기궤제여하조환자혈청MIF、VEGF、VEGFR1、VEGFR2표체유관。
Objective To investigate the effects of mifepristone combined with laparoscopic surgery on serum macrophage migration inhibition factor ( MIF ) , vascular endothelial growth factor ( VEGF ) and its receptors ( VEGF1, VEGF2) in patients with endometriosis.Methods A total of 90 patients with endometriosis who were admitted into our hospital from January 2012 to January 2015 were randomly divided into observation group ( n =45) and control group ( n =45).The patients in control group were treated by laparoscopic surgery, however, the patients in observation group,on the basis of control group.were treated by mifepristone,with a treatment course of 6 months for both groups.After treatment, the therapeutic effects, one-year conception rate, serum levels of hs-CRP, CA125, MIF, VEGF, VEGFR1, VEGFR2 and postoperative relapse rate were observed and compared between two groups.Results The total effective rates in observation group were significantly higher than those in control group( 93.33%vs 75.56%, P <0.05).The one-year conception rate in observation group was significantly higher than that in control group (33.33%vs 17.78%, P <0.05).After treatment, the pelvic mass volume, serum levels of hs-CRP, CA125, MIF, VEGF, VEGFR1, VEGFR2, EHP-5 scores were obviously improved,as compared with those before treatment in both groups ( P <0.05), moreover, the improvement degree in observation group was superior to that of control group ( P <0.05).All the patients were followed up for 1 year, the relapse rate in observation group was significantly lower than that of control group (6.67% vs 26.67%, P <0.05).Conclusion The laparoscopic surgery combined with mifepristone is effective in treating endometriosis, which can obviously increase conception rate, decrease postoperative relapse rate and improve life quality of patients, and its action mechanism may be related to the down-regulation of expression levels of MIF, VEGF, VEGFR1, VEGFR2.